Newton RCUK-SEAMED - Assessing the health impacts of air pollution in Thailand

Air pollution is an important preventable cause of illness and disease around the world. Pollution levels in many South East Asian countries are higher than are typically found in the UK and other European countries. In Thailand there are often unhealthy concentrations of ozone and airborne fine particulate matter in cities and towns. These pollutants are mostly caused by road traffic and industrial emissions. The pollution is regularly exacerbated by smoke (haze) from regional forest burning, which mostly affects the northern provinces of Thailand. Indoor air pollution levels are also higher in Thailand and other countries in the region than in the UK, which is partly because of ingress of outdoor pollutants, but is also due to second hand cigarette smoke and emissions from burning of charcoal, incense and other materials.

It is important for government, industry and other stakeholders in Thailand to have a good understanding of the health impact from indoor and outdoor pollutants. In particular, the number of people living with disease caused by air pollution and the annual number of premature deaths from air pollutants, linked to the main sources. Knowledge of the health impacts is a prerequisite for developing appropriate intervention strategies to prevent future disease.

This project will collect a wide range of already available data on air pollution concentrations, population demographics, along with mortality and morbidity statistics. In addition, we will collect new data on indoor and outdoor pollution in urban and rural residences, and data on the time-activity patterns of a sample of the Thai population using a questionnaire. We will carefully review the published scientific evidence for the associations between air pollutants and health to derive appropriate mathematical relationships that can be used to predict the impact of long-term exposure on the health of the Thai population. In addition, we will produce a model of pollution exposure to the Thai population based on the available data. The health impacts will be expressed as an annual numbers of premature deaths and the total number of population years that are lost or lived with disease (as disability-adjusted life years or DALYS). We will include a range of chronic diseases known to be caused by air pollution and diseases for which the evidence for an association is still emerging, although these data will be reported separately. Importantly, we will explicitly attempt to account for all uncertainties involved in the calculations so that we can express our evaluation in terms of the like range of impacts rather than as single figures. This approach is novel, and will allow us to identify the main sources of uncertainty in our estimates and make recommendations to improve the data available for future evaluations.

An important aspect of the project is early engagement with a wide range of stakeholders in Thailand to ensure we take account of a wide range of views and that we gain access to all relevant data. At the end of the project we plan to re-engage with these stakeholders to start a dialogue about possible practical intervention strategies to reduce future risks.

Our aim is to influence the public health debate about the importance of reducing exposure to indoor and outdoor pollution in Thailand by raising awareness of the size of the size of the associated health impact. We want to encourage better public health regulation and policies, and to help citizens reduce their risks. The main beneficiaries of the research will be the Thai population and people living in other countries in South East Asia with similar pollution problems.

In the early stages of the project, we will seek to have meetings with some of the key stakeholder groups to update them about our plans and to get their input into the strategies for the research and data availability. We will recruit a small number of stakeholders to the Project Advisory Board. In addition, we will produce a project website with a lay summary of the scientific evidence linking indoor and outdoor pollutants to disease along with an outline of our research project. We will use social media (e.g. Twitter) throughout the project to add to the information dissemination via the project website, and to interact with the wider community and gain a greater insight into their concerns about indoor and outdoor pollution.

Journalists play an important role in disseminating information about the health impacts of pollution. We will make contact with specialist journalists in Thailand to explain to purpose of our research and to highlight the various data that will come from the project, with the hope that we can help promote more reliable content in the media. We will issue a press release at the start of our project to describe the work and towards the end of the work to highlight our findings. We will regularly write short informative articles on air pollution and health risk factors for inclusion on our project website.

We will stress the potential impacts of periodic haze events in Thailand on the health and wellbeing of citizens and provide practical advice on how to minimise risks of disease related to pollution. We will write short articles for our website about possible intervention strategies to reduce risks, particularly strategies that individuals control such as wearing a mask, the use of filter freestanding particle units in the home and staying indoors during periods of high pollution concentrations.

It is our intention to communicate with our scientific colleagues in the normal way through presentations at appropriate scientific conferences and publications in high-impact peer-reviewed journals. Conferences in the region will be particularly targeted.

We will have a public dialogue at the end of our project to present the findings and engage all stakeholder groups in the findings and the prospect for further practical efforts to reduce the at-risk populations exposure to indoor and outdoor pollution. In particular, we will renew contacts with government officials to ensure they are fully aware of our findings. We will make use of contacts made with media journalists to get the final message out to a wider public. The results of the study will be made available on the project website in an accessible way.